1 00:00:00,275 --> 00:00:02,875 - Phillips is focused on innovation to improve the health 2 00:00:02,975 --> 00:00:05,155 and wellbeing of people, our devices 3 00:00:05,295 --> 00:00:08,515 and device agnostic informatics solutions can scale across 4 00:00:08,515 --> 00:00:11,755 your enterprise to help care teams diagnose, treat, 5 00:00:11,935 --> 00:00:14,435 and manage patients with accuracy, speed, 6 00:00:14,615 --> 00:00:17,555 and confidence by connecting the digital patient's story. 7 00:00:17,725 --> 00:00:20,115 Physicians and clinicians have intelligence 8 00:00:20,135 --> 00:00:23,355 for decision making in the moment and insight to see beyond. 9 00:00:23,665 --> 00:00:25,835 It's our privilege to partner with you, to care 10 00:00:25,855 --> 00:00:28,435 for the carers, and to improve the lives of the people 11 00:00:28,575 --> 00:00:29,875 and patients they serve. 12 00:00:30,835 --> 00:00:32,675 Phillips Innovation. And you? 13 00:00:33,545 --> 00:00:35,875 - This is Kate Cruz at the eighth Annual Becker's, 14 00:00:35,995 --> 00:00:39,155 HIT digital health RCM conference in Chicago. 15 00:00:39,735 --> 00:00:40,915 I'm here with Michael Hassel. 16 00:00:40,945 --> 00:00:42,115 Michael, to get us started, 17 00:00:42,215 --> 00:00:43,435 can you share a bit about yourself, 18 00:00:43,435 --> 00:00:44,755 your role, and your organization? 19 00:00:45,185 --> 00:00:47,635 - Sure. Love to. Um, thanks for having me. 20 00:00:47,855 --> 00:00:49,795 Uh, Michael Hasselbeck. 21 00:00:49,795 --> 00:00:54,115 First and foremost, I'm a nurse, um, who early in my career, 22 00:00:54,305 --> 00:00:55,475 kind of my claim 23 00:00:55,535 --> 00:00:59,275 to fame was developing a statewide telemedicine program 24 00:00:59,335 --> 00:01:01,395 before telemedicine was a cool thing 25 00:01:01,495 --> 00:01:03,795 or even reimbursed in the state of New York. 26 00:01:04,015 --> 00:01:07,835 Uh, continued to to move on in the innovation space 27 00:01:08,055 --> 00:01:11,115 and, uh, currently serve as the Chief Digital Health officer 28 00:01:11,415 --> 00:01:13,515 for the University of Rochester Health System. 29 00:01:13,785 --> 00:01:15,875 - Fantastic. Thank you for that introduction. 30 00:01:16,025 --> 00:01:17,115 Michael, when you think 31 00:01:17,115 --> 00:01:19,115 of digital innovation in healthcare right now, 32 00:01:19,115 --> 00:01:20,435 what is exciting you the most? 33 00:01:20,935 --> 00:01:23,915 - Oh boy. You know, I, I, I'm probably gonna give an answer 34 00:01:23,915 --> 00:01:27,035 that a lot of other folks have already given generative ai 35 00:01:27,415 --> 00:01:30,755 and I am absolutely bullish about generative ai. 36 00:01:31,015 --> 00:01:34,995 And, you know, one of the things that you know, is really 37 00:01:36,155 --> 00:01:40,715 exciting for us is our innovation team got early access 38 00:01:41,015 --> 00:01:45,515 to GPT four on a secured private Azure instance. 39 00:01:45,515 --> 00:01:46,835 And we've had it now for months, 40 00:01:46,895 --> 00:01:48,875 and we have been putting PHI into it 41 00:01:48,875 --> 00:01:52,755 and really testing its boundaries of what it can do well 42 00:01:52,855 --> 00:01:54,315 and, and where does it fall down. 43 00:01:54,775 --> 00:01:56,835 And I have now come 44 00:01:56,835 --> 00:01:59,115 to the conclusion it has never been easier 45 00:01:59,255 --> 00:02:00,715 for health systems like mine 46 00:02:01,135 --> 00:02:04,155 to develop our own point solutions to solve our problems. 47 00:02:04,415 --> 00:02:08,195 My dev time on my innovation team has gone from six months 48 00:02:08,215 --> 00:02:11,715 to a year to days to weeks using this technology. 49 00:02:11,895 --> 00:02:15,395 So I am convinced this may be the first technology ever 50 00:02:16,055 --> 00:02:19,395 in healthcare that's gonna make the lives of clinicians 51 00:02:19,415 --> 00:02:21,155 and providers easier. Yeah, 52 00:02:21,185 --> 00:02:22,635 - That would, that would be fantastic. 53 00:02:23,155 --> 00:02:26,755 . Um, what, so you're clearly, you know, 54 00:02:26,755 --> 00:02:28,275 at the forefront of this innovation, 55 00:02:28,465 --> 00:02:32,395 what have been some early key learnings for you 56 00:02:32,535 --> 00:02:33,755 and your organization? 57 00:02:35,155 --> 00:02:38,245 - Yeah, you know, again, with the generative AI stuff, uh, 58 00:02:38,425 --> 00:02:42,285 really emphasizing that it is now really easy 59 00:02:42,385 --> 00:02:43,445 to build solutions. 60 00:02:43,745 --> 00:02:45,565 You know, I'll give a a really good example. 61 00:02:45,905 --> 00:02:49,005 You know, one problem that my health system struggles with, 62 00:02:49,005 --> 00:02:51,845 which I would argue probably every health system in the 63 00:02:51,845 --> 00:02:54,845 country is struggling with right now, is patient messages 64 00:02:54,905 --> 00:02:56,765 and patient messages burning out. 65 00:02:56,765 --> 00:02:59,725 The clinicians, especially, you know, with C-O-V-I-D 66 00:02:59,785 --> 00:03:01,605 and opening up our patient portals, 67 00:03:01,825 --> 00:03:04,445 our patients have never had more, you know, 68 00:03:04,965 --> 00:03:06,125 seamless direct access 69 00:03:06,125 --> 00:03:08,045 to our clinicians than they ever did before. 70 00:03:08,905 --> 00:03:10,205 Now, the simple problem 71 00:03:10,385 --> 00:03:12,685 of a patient message coming into the health system 72 00:03:12,705 --> 00:03:15,725 and then saying, this message should go to a staff member. 73 00:03:15,955 --> 00:03:17,565 This message should go to a nurse, 74 00:03:17,915 --> 00:03:19,485 this message should go to a provider. 75 00:03:19,545 --> 00:03:21,325 You think that'd be a super easy 76 00:03:21,325 --> 00:03:22,685 problem that we could solve. 77 00:03:24,035 --> 00:03:28,525 It's not, and my team, several years ago, actually right 78 00:03:28,525 --> 00:03:31,325 before covid, we tried attacking this problem. 79 00:03:31,785 --> 00:03:34,005 Um, I put about two full-time 80 00:03:34,035 --> 00:03:35,685 data scientists on this problem. 81 00:03:36,365 --> 00:03:38,685 I had a whole kind of cadre 82 00:03:38,705 --> 00:03:40,685 of primary care docs labeling data, 83 00:03:40,985 --> 00:03:43,685 and we tried building our own NLP models, 84 00:03:43,685 --> 00:03:47,045 natural language processing models to triage these messages. 85 00:03:47,465 --> 00:03:50,245 We first tried taking a structured approach to this problem, 86 00:03:50,665 --> 00:03:52,645 and we realized we didn't have enough resources 87 00:03:52,785 --> 00:03:54,925 to essentially build our own labeled 88 00:03:55,555 --> 00:03:57,285 data set large enough to solve it. 89 00:03:57,305 --> 00:03:59,005 We then took an unstructured approach 90 00:03:59,025 --> 00:04:01,445 and just said, machine, you determine 91 00:04:01,495 --> 00:04:03,085 where the patterns are in this data. 92 00:04:03,265 --> 00:04:05,965 Can you group those, those messages appropriately? 93 00:04:06,185 --> 00:04:08,365 And what we found out, the machine could not do it. 94 00:04:08,745 --> 00:04:12,645 Upside of that was when startup companies would approach me 95 00:04:12,665 --> 00:04:14,565 and my role of Chief Digital Officer 96 00:04:14,665 --> 00:04:17,925 and say, Hey, I know you've got a patient messaging problem. 97 00:04:18,525 --> 00:04:20,845 I have a machine learning algorithm to solve that problem. 98 00:04:21,085 --> 00:04:23,325 I could say to those companies, you're full of it, , 99 00:04:23,445 --> 00:04:26,485 I know for a fact you ha do not have an, 100 00:04:26,485 --> 00:04:27,725 an algorithm to solve this. 101 00:04:28,235 --> 00:04:31,125 Fast forwarded generative ai, as I said, you know, 102 00:04:31,125 --> 00:04:33,445 we got early access to GPT four, 103 00:04:33,545 --> 00:04:36,845 and the first thing I told my team is I wanna re-attack. 104 00:04:36,845 --> 00:04:41,645 That MyChart messaging problem took us two days, two days 105 00:04:41,865 --> 00:04:44,965 to tune GPT four to triage those messages 106 00:04:44,965 --> 00:04:49,045 with 97% reliability, 87% accuracy. 107 00:04:49,265 --> 00:04:52,925 We ran it in a shadow pilot comparing it to our human nurse 108 00:04:53,035 --> 00:04:55,925 that manages those message pools. 109 00:04:56,225 --> 00:05:00,625 The AI outperforms the human nurse. Pretty impressive. 110 00:05:01,005 --> 00:05:04,305 That's just the beginning of lots of different solutions 111 00:05:04,335 --> 00:05:08,105 that now we as a health system can build ourselves, 112 00:05:08,675 --> 00:05:11,745 leveraging these already massive pre-trained models. 113 00:05:11,975 --> 00:05:14,545 - Well, and it, I mean, that's a fantastic example. 114 00:05:14,765 --> 00:05:16,105 I'm kind of mind blown here. 115 00:05:16,525 --> 00:05:18,865 Um, I can only like, 116 00:05:18,865 --> 00:05:21,665 and you say it's almost a hundred percent accuracy, 117 00:05:21,665 --> 00:05:24,225 but even, you know, when, if it isn't a hundred percent 118 00:05:24,545 --> 00:05:26,665 accurate, I'm sure the message still gets to some, a human 119 00:05:26,665 --> 00:05:28,025 that knows what to do with it. 120 00:05:28,295 --> 00:05:30,745 Whether it's, you know, they can't answer the question 121 00:05:30,745 --> 00:05:32,225 and just, you know, wasn't directly for them, 122 00:05:32,285 --> 00:05:34,705 or they can forward it onto who it does belong to, 123 00:05:34,955 --> 00:05:36,025 which still, you know, 124 00:05:36,935 --> 00:05:38,915 that's not 300 messages a day in the 125 00:05:39,035 --> 00:05:40,235 provider's inbox. So 126 00:05:40,395 --> 00:05:41,395 - E Exactly. 127 00:05:41,395 --> 00:05:43,715 Exactly. And you know, I've told my innovation team, 128 00:05:44,015 --> 00:05:47,315 you know, where we're gonna focus this, this new technology, 129 00:05:47,975 --> 00:05:49,875 all non-patient facing applications. 130 00:05:50,215 --> 00:05:54,115 Now it has potential in patient facing applications, 131 00:05:54,115 --> 00:05:55,675 but we're not there yet culturally. 132 00:05:55,695 --> 00:05:57,165 Mm-Hmm, . But there's a lot, lot 133 00:05:57,165 --> 00:06:00,525 of waste in healthcare on the non-patient facing side 134 00:06:00,525 --> 00:06:02,365 where you still have a human in the loop. 135 00:06:03,345 --> 00:06:05,325 Boy that's just low hanging fruit. 136 00:06:05,505 --> 00:06:09,485 So where my priorities are, are actually now my providers, 137 00:06:09,545 --> 00:06:12,165 my clinicians, my workforce, like how can 138 00:06:12,765 --> 00:06:16,485 I free up their time so they can actually spend more time 139 00:06:16,515 --> 00:06:18,725 with the patient doing what they went to school for, 140 00:06:18,985 --> 00:06:20,885 and how do I get 'em out of work on time 141 00:06:20,905 --> 00:06:22,525 so they can go spend it with their family? 142 00:06:22,585 --> 00:06:23,645 Mm-Hmm, that's 143 00:06:23,645 --> 00:06:25,685 where their opportunity is with this technology. 144 00:06:25,785 --> 00:06:29,205 And we're, we're coming up with lots of different, uh, uh, 145 00:06:29,205 --> 00:06:30,925 applications to help re remove 146 00:06:30,925 --> 00:06:32,445 that burden off of my clinicians. 147 00:06:32,545 --> 00:06:35,765 - That's awesome. So moving on to my next question, um, 148 00:06:36,065 --> 00:06:38,005 and you've kind of touched on this a little bit already. 149 00:06:38,035 --> 00:06:41,905 What are the top priorities that you are setting 150 00:06:41,965 --> 00:06:45,345 for technology and like, what are the, in addition to, 151 00:06:45,485 --> 00:06:46,585 you know, physician messages, 152 00:06:46,585 --> 00:06:48,585 what are some other issues that you're trying to solve? So, 153 00:06:48,585 --> 00:06:49,585 - It's a great question. 154 00:06:49,585 --> 00:06:52,985 So, when I started my role, um, 155 00:06:53,485 --> 00:06:55,785 as Chief Digital Health Officer for the health system, 156 00:06:56,245 --> 00:06:58,785 you know, several years ago, you know, my first 157 00:06:59,385 --> 00:07:00,505 priority was access. 158 00:07:00,925 --> 00:07:05,105 So, you know, how do I leverage the technology that 159 00:07:05,685 --> 00:07:09,225 my patients already have, their smartphones, their tablets, 160 00:07:09,225 --> 00:07:12,465 their computers to more conveniently 161 00:07:12,565 --> 00:07:15,145 and seamlessly enter into my health system. 162 00:07:15,245 --> 00:07:20,105 So we spent two years building out our digital front door, 163 00:07:20,645 --> 00:07:23,225 um, and we've had a lot of success there. 164 00:07:23,525 --> 00:07:27,785 We then moved on to what I call digital patient engagement. 165 00:07:28,045 --> 00:07:31,865 How do I create that stickiness or that glue? 166 00:07:32,085 --> 00:07:34,585 Now I've made it easy for my patients 167 00:07:34,585 --> 00:07:35,785 to enter into the health system. 168 00:07:35,805 --> 00:07:38,505 How do I keep them engaged, engaged in my service lines? 169 00:07:38,605 --> 00:07:40,505 But it just engaged in health promotion 170 00:07:40,505 --> 00:07:42,905 and health pro prevention in general. 171 00:07:43,815 --> 00:07:47,545 However, we've had to make a really significant pivot. 172 00:07:48,455 --> 00:07:49,825 Instead of continuing 173 00:07:49,825 --> 00:07:52,585 to build out those patient engagement opportunities 174 00:07:52,685 --> 00:07:56,235 and solutions, I've had a really shift 175 00:07:56,905 --> 00:07:58,155 over to my clinicians. 176 00:07:58,255 --> 00:08:00,075 And the reason is is, you know, 177 00:08:00,615 --> 00:08:02,795 we created all this access, which is fantastic. 178 00:08:03,375 --> 00:08:05,195 Our patients have never been more engaged, 179 00:08:05,815 --> 00:08:08,955 but I've got a physician workforce, a nursing workforce 180 00:08:09,345 --> 00:08:13,355 that is on the ledge, you know, burnt out, ready to leave. 181 00:08:13,935 --> 00:08:16,955 And so we're really honing in on 182 00:08:17,135 --> 00:08:18,795 how do we make their lives better? 183 00:08:18,795 --> 00:08:21,195 Because if I don't have a clinical workforce, 184 00:08:21,335 --> 00:08:24,435 it doesn't matter what technology I introduce 185 00:08:24,455 --> 00:08:27,315 to my patients, it's not gonna be successful. Yeah, 186 00:08:27,795 --> 00:08:28,795 - Absolutely. 187 00:08:28,795 --> 00:08:31,755 Where, and this isn't really a techno technology question, 188 00:08:31,815 --> 00:08:33,835 but it could be if there's, you know, a solution 189 00:08:33,835 --> 00:08:36,195 that you have in mind, but where is that balance 190 00:08:36,305 --> 00:08:38,595 between patient access to their provider 191 00:08:39,175 --> 00:08:42,755 and a provider still being sane ? 192 00:08:44,235 --> 00:08:46,735 - Oh boy, that is a, that is a, a tough question. 193 00:08:46,735 --> 00:08:51,575 And I think it's different from one clinician to another. 194 00:08:52,235 --> 00:08:57,025 Um, and you know, I think technology 195 00:08:57,805 --> 00:09:01,665 to date has opened up access points. 196 00:09:01,885 --> 00:09:05,105 Mm-Hmm. , like on the patient facing side, lot 197 00:09:05,105 --> 00:09:06,225 of success there. 198 00:09:06,445 --> 00:09:07,905 So the access points are open, 199 00:09:09,305 --> 00:09:12,285 the capacity on the other side is not there, 200 00:09:12,505 --> 00:09:17,165 and we're not going to double our workforce overnight. 201 00:09:17,665 --> 00:09:19,885 So, you know, we still need 202 00:09:19,885 --> 00:09:22,085 to continue on the patient facing side of 203 00:09:22,585 --> 00:09:25,085 how can we now leverage technologies in new ways 204 00:09:25,085 --> 00:09:27,445 where maybe you don't need a clinician on the other side. 205 00:09:27,785 --> 00:09:31,285 So maybe in the future, generative AI can just interact 206 00:09:31,285 --> 00:09:34,845 with patients and maybe take a lot of the, the, 207 00:09:34,845 --> 00:09:37,405 that interaction burden off of the, the, the clinician. 208 00:09:37,415 --> 00:09:39,005 Maybe we will eventually get there. 209 00:09:39,005 --> 00:09:43,125 And I think there's opportunities in digital therapeutics 210 00:09:43,425 --> 00:09:44,685 and mobile apps 211 00:09:44,735 --> 00:09:46,925 where you don't need a clinician on the other end to help 212 00:09:47,705 --> 00:09:50,165 reduce some of that capacity side. 213 00:09:50,265 --> 00:09:53,725 But at the same time, you know, again, really emphasizing 214 00:09:53,725 --> 00:09:54,765 and honing in at that point. 215 00:09:54,965 --> 00:09:58,045 I do have a workforce that went to school to do this, 216 00:09:58,515 --> 00:10:00,285 that are passionate about helping others 217 00:10:00,985 --> 00:10:03,365 who really wanna be able to do that well 218 00:10:03,585 --> 00:10:04,765 and wanna have more of 219 00:10:04,765 --> 00:10:07,165 that face-to-face clinical interaction. 220 00:10:07,225 --> 00:10:08,325 And I need to make that happen 221 00:10:08,325 --> 00:10:10,845 because our electronic health record 222 00:10:11,635 --> 00:10:13,685 made it worse on our clinicians. 223 00:10:13,945 --> 00:10:16,965 Uh, so, you know, really, again, freeing up their time, 224 00:10:17,185 --> 00:10:19,525 giving them that passion back, um, 225 00:10:20,065 --> 00:10:24,005 and joy back to, to delivering clinical care, to me is 226 00:10:24,265 --> 00:10:27,405 by far my biggest focus and priority. Absolutely. 227 00:10:27,405 --> 00:10:28,685 - That totally makes sense. 228 00:10:29,235 --> 00:10:31,245 What is a piece of advice you would give 229 00:10:31,265 --> 00:10:32,325 to healthcare leaders 230 00:10:32,585 --> 00:10:36,525 or other people in your role regarding digital innovation? 231 00:10:37,515 --> 00:10:39,645 - Diversity of thought and partnerships? 232 00:10:40,185 --> 00:10:43,765 You know, my innovation team is very, 233 00:10:43,765 --> 00:10:45,845 very diverse in my group. 234 00:10:46,365 --> 00:10:47,965 I have a music professor, 235 00:10:48,645 --> 00:10:52,525 I have an English faculty member, I have a chaplain, 236 00:10:53,435 --> 00:10:56,965 partnered with engineers, partnered with data scientists, 237 00:10:56,965 --> 00:11:00,045 partnered with computer scientists under the same roof 238 00:11:00,185 --> 00:11:01,805 as faculty from my medical school, 239 00:11:01,905 --> 00:11:03,565 dental school, and nursing school. 240 00:11:04,215 --> 00:11:06,125 We're not a research shop. 241 00:11:06,385 --> 00:11:10,365 Our expectation is not to get grants, published papers. 242 00:11:10,975 --> 00:11:12,965 We're truly the innovation team 243 00:11:13,345 --> 00:11:14,605 to support the health system. 244 00:11:15,305 --> 00:11:18,645 The type of solutions that we've been able to come up 245 00:11:18,645 --> 00:11:21,565 with using design thinking processes, leveraging 246 00:11:21,565 --> 00:11:25,245 that diversity of thought has been really impactful. 247 00:11:25,505 --> 00:11:29,565 Really, really powerful. The other thing is partnerships. 248 00:11:29,985 --> 00:11:34,125 You know, I am, I'm actually really excited about the 249 00:11:34,125 --> 00:11:35,965 disruptors entering into healthcare. 250 00:11:36,345 --> 00:11:39,245 You know, there, there's a lot of discussion of, oh my gosh, 251 00:11:39,245 --> 00:11:41,245 should we be trying to compete 252 00:11:41,245 --> 00:11:43,285 with these big retailers moving in? 253 00:11:43,825 --> 00:11:46,205 Oh my gosh, should we be trying to compete 254 00:11:46,205 --> 00:11:48,125 with the big tech companies moving in? 255 00:11:48,565 --> 00:11:50,165 I say it's the exact opposite. 256 00:11:50,175 --> 00:11:53,725 There, there are things that the disruptors do really, 257 00:11:53,725 --> 00:11:55,605 really well, given their experiences 258 00:11:55,665 --> 00:11:58,685 and other verticals that are outside of healthcare. 259 00:11:59,265 --> 00:12:01,565 So there are opportunities to learn with from them, 260 00:12:01,675 --> 00:12:02,725 partner with them. 261 00:12:03,065 --> 00:12:06,445 And at the same time, we have a lot of, as incumbents 262 00:12:06,545 --> 00:12:08,965 as health systems, we bring a lot of knowledge. 263 00:12:08,965 --> 00:12:11,045 We bring a lot to the table to help 264 00:12:11,915 --> 00:12:14,445 what they're doing in healthcare that much stronger, 265 00:12:14,555 --> 00:12:15,565 that much more impactful. 266 00:12:15,785 --> 00:12:19,565 So I'm all about seeking outside of the box partnerships 267 00:12:19,795 --> 00:12:23,885 with industry, with retail, with startups, um, 268 00:12:24,565 --> 00:12:26,965 'cause I just think it's gonna make healthcare in general 269 00:12:27,065 --> 00:12:28,645 better for all of us. Yeah, 270 00:12:28,645 --> 00:12:31,485 - That's been a little bit of a theme that I've heard of, 271 00:12:32,025 --> 00:12:34,045 you know, partnering rather than competing 272 00:12:34,045 --> 00:12:37,265 and how that's just gonna make it easier, make it better, 273 00:12:38,435 --> 00:12:40,055 and the way to go overall. 274 00:12:40,515 --> 00:12:43,215 Um, is there a specific example that you want to share 275 00:12:43,215 --> 00:12:45,775 where integration of informatics led 276 00:12:45,775 --> 00:12:47,095 to improved patient outcomes 277 00:12:47,195 --> 00:12:49,295 or enhanced patient provider communication? 278 00:12:49,295 --> 00:12:50,855 You've already kind of given some, but any other 279 00:12:51,015 --> 00:12:52,015 - ? 280 00:12:52,015 --> 00:12:53,015 Yeah, you know, I've been, go actually old school, 281 00:12:53,195 --> 00:12:54,455 you know, okay, I'm gonna go, I'm better. 282 00:12:54,455 --> 00:12:58,815 Go back to an old technology today. Telemedicine. 283 00:12:58,815 --> 00:13:00,775 Okay. Right. Yeah. Covid hits 284 00:13:01,825 --> 00:13:03,135 every health system in the country. 285 00:13:03,355 --> 00:13:06,735 We had to turn on telemedicine like overnight. Yep. 286 00:13:07,165 --> 00:13:09,975 Some of us had experience in telemedicine, so it was easier 287 00:13:10,035 --> 00:13:11,215 to make that transition. 288 00:13:11,755 --> 00:13:14,055 But we went from, you know, 289 00:13:14,155 --> 00:13:19,135 our outpatient volumes being 3% telemedicine prior 290 00:13:19,155 --> 00:13:23,055 to C-O-V-I-D to literally within a week up to 80 90% of 291 00:13:23,055 --> 00:13:25,815 what we were doing telemedicine focus. 292 00:13:26,755 --> 00:13:29,095 Now, when I think of informatics 293 00:13:29,115 --> 00:13:33,295 and I think of both my clinical informaticists, um, 294 00:13:33,595 --> 00:13:37,935 on the physician and nursing side, we really leveraged data 295 00:13:38,485 --> 00:13:42,655 from those groups to inform how we deploy telemedicine, 296 00:13:42,665 --> 00:13:44,375 where we deploy telemedicine. 297 00:13:44,835 --> 00:13:48,405 Um, you know, things that we did were 298 00:13:49,395 --> 00:13:51,605 geocoding all of our patients knowing 299 00:13:51,605 --> 00:13:54,005 where they were located, what social determinants 300 00:13:54,005 --> 00:13:55,725 of health they face, you know, 301 00:13:56,265 --> 00:13:59,005 was there internet connectivity out in those areas? 302 00:13:59,665 --> 00:14:00,685 Um, you know, 303 00:14:00,875 --> 00:14:05,005 were they only engaging in audio only telehealth versus 304 00:14:05,055 --> 00:14:06,405 video only telehealth? 305 00:14:07,025 --> 00:14:09,405 And some of the things that we learned from that, 306 00:14:09,405 --> 00:14:10,925 that continues to form 307 00:14:11,705 --> 00:14:15,765 our evolution in telehealth was in my rural communities 308 00:14:15,765 --> 00:14:17,005 that my health system serves. 309 00:14:17,005 --> 00:14:20,325 And we're, we're the largest health system in New York 310 00:14:20,325 --> 00:14:21,565 state, outside of New York City. 311 00:14:21,825 --> 00:14:26,165 So we have a massive geographic reach where you go 20 miles 312 00:14:26,195 --> 00:14:28,205 outside of the city of Rochester. 313 00:14:28,305 --> 00:14:31,365 It is very, very rural, you know, uh, uh, 314 00:14:31,365 --> 00:14:32,965 farming communities. Um, 315 00:14:33,265 --> 00:14:34,405 - I'm an Iowan . Yeah, 316 00:14:34,405 --> 00:14:35,405 - Yeah. 317 00:14:35,405 --> 00:14:37,205 You know, you know, and you know, 318 00:14:37,275 --> 00:14:39,965 what we had learned in the state of New York, you know, 319 00:14:40,705 --> 00:14:43,805 our previous government leadership has made a significant 320 00:14:43,805 --> 00:14:44,965 investment in broadband. 321 00:14:45,105 --> 00:14:47,685 So there was broadband out in these communities. 322 00:14:47,685 --> 00:14:51,045 So it wasn't an access to having internet 323 00:14:51,125 --> 00:14:52,365 to engage in telemedicine. 324 00:14:52,505 --> 00:14:56,485 It was poverty that these rural communities were some 325 00:14:56,485 --> 00:14:58,885 of the highest poverty communities 326 00:15:00,215 --> 00:15:01,545 that, uh, we served. 327 00:15:02,085 --> 00:15:04,545 And they couldn't afford internet in their homes. 328 00:15:04,765 --> 00:15:07,905 So the only internet that they had access to 329 00:15:08,415 --> 00:15:10,625 were the data plans on their cell phones. 330 00:15:11,365 --> 00:15:13,945 And video is very data intensive. 331 00:15:14,125 --> 00:15:16,145 And so our patients said, you know, 332 00:15:16,905 --> 00:15:18,345 I can't use up my data plan 333 00:15:18,485 --> 00:15:20,465 for a video telemedicine appointment, 334 00:15:20,465 --> 00:15:21,825 but I will engage in audio 335 00:15:21,825 --> 00:15:24,625 because you, I have unlimited, uh, texts 336 00:15:24,625 --> 00:15:27,625 and speech for most telecommunication plans. 337 00:15:28,485 --> 00:15:31,105 So what that led for us was, you know, 338 00:15:31,105 --> 00:15:33,185 doing a deep dive into our data, we found 339 00:15:33,185 --> 00:15:35,945 that it was actually these patients in these communities. 340 00:15:35,965 --> 00:15:38,305 It was our Medicaid patients, our safety net, 341 00:15:38,305 --> 00:15:40,465 our uninsured patients that had the biggest 342 00:15:41,225 --> 00:15:42,825 benefits from telehealth in our community. 343 00:15:42,825 --> 00:15:46,625 It was our informaticists that helped drive those insights. 344 00:15:47,285 --> 00:15:49,905 So what we did with it was kind of twofold. 345 00:15:50,205 --> 00:15:52,185 One, we did a very large analysis, one 346 00:15:52,185 --> 00:15:54,505 of the first in the country, which we published in the New 347 00:15:54,505 --> 00:15:56,945 England Journal of Medicine Catalyst about a year ago, 348 00:15:56,945 --> 00:16:00,625 showing that for the Medicaid patient population, 349 00:16:00,685 --> 00:16:02,745 all the myths that payers use to say, 350 00:16:02,805 --> 00:16:06,065 I'm not gonna reimburse telemedicine at parody. 351 00:16:06,525 --> 00:16:09,185 We busted 'em all and got that, got that out there. 352 00:16:09,245 --> 00:16:12,265 So really kind of driving large policy change in the country 353 00:16:12,365 --> 00:16:14,625 around continuing to pay for telemedicine. 354 00:16:14,645 --> 00:16:17,545 The other thing is we're thinking outside of the box for 355 00:16:17,915 --> 00:16:21,305 where can we set up essentially telemedicine 356 00:16:22,505 --> 00:16:24,145 locations in the community were 357 00:16:24,535 --> 00:16:26,425 that are convenient for patients. 358 00:16:26,565 --> 00:16:28,785 One of the things when we talk about the disruptors 359 00:16:29,095 --> 00:16:32,465 that I thought was potentially really, really transformative 360 00:16:33,205 --> 00:16:37,625 was in July of 2020 $1 General comes out 361 00:16:37,625 --> 00:16:39,425 and says, we're getting into healthcare. 362 00:16:39,555 --> 00:16:41,625 We've hired a Chief Medical officer. 363 00:16:42,565 --> 00:16:44,785 So getting back to our geocoding 364 00:16:44,785 --> 00:16:47,745 of our patients at the University of Rochester, outside 365 00:16:47,745 --> 00:16:52,265 of our city limits, 75% of our patients live 10 miles 366 00:16:52,325 --> 00:16:56,305 or more to the closest primary care office. 367 00:16:56,765 --> 00:16:59,705 And it gets even worse for our urgent care offices 368 00:17:00,455 --> 00:17:02,105 looking at those same patients. 369 00:17:02,105 --> 00:17:05,305 And we geocoded the Dollar Generals in our market, 370 00:17:05,765 --> 00:17:08,545 85% of our patients outside 371 00:17:08,545 --> 00:17:10,705 of the city limits live within two 372 00:17:10,725 --> 00:17:12,345 to three miles of a Dollar General. 373 00:17:12,805 --> 00:17:16,745 So you think about that, what a great opportunity to think 374 00:17:16,745 --> 00:17:17,825 outside of the box 375 00:17:18,005 --> 00:17:20,145 to capture patients in their own communities 376 00:17:20,145 --> 00:17:22,705 where we know we have broadband, we know we have wifi, 377 00:17:23,285 --> 00:17:25,785 and we could deliver telemedicine into those settings. 378 00:17:25,885 --> 00:17:26,985 Now, Dr. 379 00:17:27,245 --> 00:17:30,185 Wu, the CMO of Dollar General is still figuring out, 380 00:17:30,245 --> 00:17:32,345 you know, what their path forward and strategy is, 381 00:17:32,445 --> 00:17:34,305 but it just gives you that concept of 382 00:17:34,305 --> 00:17:37,145 where there's opportunities to create new partnerships 383 00:17:37,685 --> 00:17:39,385 to deliver care into these communities. 384 00:17:39,385 --> 00:17:42,305 And again, informatics drove us that direction. Yeah, 385 00:17:42,305 --> 00:17:43,505 - That's really interesting. 386 00:17:43,525 --> 00:17:46,385 You know, hearing Dollar General, which 387 00:17:47,175 --> 00:17:48,905 it's a name, we all know what it means. 388 00:17:49,715 --> 00:17:51,295 And then we have the Walgreens 389 00:17:51,295 --> 00:17:53,055 and the CVSs that you think kind 390 00:17:53,055 --> 00:17:54,575 of have their foot in the door in healthcare. 391 00:17:55,115 --> 00:17:57,535 Do you know why they aren't doing these things? 392 00:17:57,875 --> 00:17:59,775 Or are they, and we just don't know about it? 393 00:18:00,245 --> 00:18:04,015 - Well, they are, you know, we know, you know, CVS Health 394 00:18:04,595 --> 00:18:08,015 as made significant investments into virtual care. 395 00:18:08,255 --> 00:18:11,575 Telecare Walgreen with Village md, you know, have, 396 00:18:11,575 --> 00:18:15,965 have done the same, you know, where there's potential 397 00:18:16,865 --> 00:18:20,755 leg up for maybe a disruptor like Dollar General 398 00:18:21,135 --> 00:18:24,835 or even a Walmart is just a larger brick 399 00:18:24,835 --> 00:18:28,955 and mortar presence in the community than what CVS has 400 00:18:29,175 --> 00:18:30,875 or what Walgreens has. 401 00:18:31,095 --> 00:18:34,955 And, you know, that scale, you know, 402 00:18:35,045 --> 00:18:36,875 could have a, a big impact. 403 00:18:36,975 --> 00:18:40,235 But, you know, I like the direction that the, 404 00:18:40,655 --> 00:18:42,435 the retail pharmacies are going. 405 00:18:42,715 --> 00:18:47,275 I like that they're partnering with, um, uh, you know, 406 00:18:47,305 --> 00:18:51,115 more kind of boutique virtual primary care entities to, 407 00:18:51,295 --> 00:18:52,395 to deliver care. 408 00:18:52,955 --> 00:18:55,355 I like that they're making significant investments in home 409 00:18:55,355 --> 00:18:57,675 care and, and, and, and, and, 410 00:18:57,675 --> 00:18:59,355 and home care, uh, partnerships. 411 00:18:59,895 --> 00:19:03,835 So I, I'm, I'm really hopeful that, um, 412 00:19:04,655 --> 00:19:08,235 the more that these new market entrants continue 413 00:19:08,235 --> 00:19:10,715 to invest in healthcare, that it's going 414 00:19:10,715 --> 00:19:13,835 to force incumbents like me to do things different. 415 00:19:13,945 --> 00:19:16,355 Yeah. And we have to do things different. Yeah. 416 00:19:16,375 --> 00:19:20,035 So I I, I think CVS and Walgreens are doing it. 417 00:19:20,235 --> 00:19:23,595 I just think others may have a larger presence. Yeah. To 418 00:19:23,785 --> 00:19:25,155 - That - Makes sense. Capture more patients. 419 00:19:25,265 --> 00:19:29,535 - That makes sense. So we, we went on to, 420 00:19:29,635 --> 00:19:32,135 we went back in the past for telemedicine way, 421 00:19:32,275 --> 00:19:33,415 way back in the past, all the way 422 00:19:33,625 --> 00:19:36,335 - Olden day - Back when I was a child. 423 00:19:36,795 --> 00:19:40,055 Um, five years from now, looking into the future, 424 00:19:40,685 --> 00:19:42,375 what do you think it's going to look like? 425 00:19:42,445 --> 00:19:45,695 What are the most significant changes that there will be 426 00:19:46,355 --> 00:19:50,335 and how do leaders and people in your role need to prepare? 427 00:19:50,725 --> 00:19:55,455 - Yeah, so, you know, I think everything always comes, 428 00:19:55,645 --> 00:19:57,855 kind of goes, comes around and comes back. 429 00:19:58,035 --> 00:20:00,295 So, you know, early days of healthcare, 430 00:20:01,225 --> 00:20:02,325 our clinicians went out 431 00:20:02,325 --> 00:20:04,885 to patients' homes like we're in patients 432 00:20:04,885 --> 00:20:06,005 homes, delivering care. 433 00:20:06,545 --> 00:20:08,325 You know, weren't having to be 434 00:20:08,995 --> 00:20:11,685 latched onto a computer, documenting those notes. 435 00:20:12,325 --> 00:20:14,405 I actually think that that is going to be the future. 436 00:20:14,465 --> 00:20:19,325 In five years from now, I think with ambient technologies, 437 00:20:20,025 --> 00:20:22,605 you know, there will not be a need for 438 00:20:23,345 --> 00:20:26,085 the electronic health record as we think of it today. 439 00:20:26,935 --> 00:20:30,125 Those interactions between patients 440 00:20:30,625 --> 00:20:33,125 and providers will be captured, you know, 441 00:20:33,135 --> 00:20:35,565 using speech recognition, which we're seeing 442 00:20:35,565 --> 00:20:38,485 with ambient documentation being captured 443 00:20:38,675 --> 00:20:41,205 with things like computer vision and sensors 444 00:20:41,225 --> 00:20:44,725 and cameras capturing those interactions, documenting. 445 00:20:44,865 --> 00:20:48,285 So the clinician can again, really focus on 446 00:20:48,915 --> 00:20:52,965 that empathetic hands-on care that they went to school for. 447 00:20:53,905 --> 00:20:55,845 And I also think 448 00:20:56,115 --> 00:20:58,965 that value-based care is going to happen. 449 00:20:59,165 --> 00:21:01,125 I know we've been talking it for, for a really, 450 00:21:01,125 --> 00:21:04,005 really long time, but we're at a tipping point. 451 00:21:04,375 --> 00:21:09,045 Covid told us that not only will patients 452 00:21:09,045 --> 00:21:13,525 and providers engage in healthcare virtually, it told us 453 00:21:13,595 --> 00:21:17,165 that the traditional fee 454 00:21:17,185 --> 00:21:19,845 for service reimbursement model is unsustainable. 455 00:21:20,705 --> 00:21:22,285 And it told us that 456 00:21:23,055 --> 00:21:26,365 healthcare in the future shouldn't be focused on 457 00:21:27,845 --> 00:21:29,465 how many surgeries can I do? 458 00:21:30,685 --> 00:21:34,345 How can I keep my hospital at 110% occupancy rates? 459 00:21:34,485 --> 00:21:35,825 How can I keep patients coming 460 00:21:36,015 --> 00:21:37,625 through the emergency department? 461 00:21:37,775 --> 00:21:39,985 It's really told us that we need to focus on 462 00:21:41,075 --> 00:21:43,455 how many days can I keep someone healthy, 463 00:21:44,445 --> 00:21:46,575 independent living in their own home? 464 00:21:47,035 --> 00:21:49,015 That's where the disruptors are making 465 00:21:49,015 --> 00:21:50,135 their large investments. 466 00:21:50,195 --> 00:21:53,455 That's what the big insurers are starting to shift towards. 467 00:21:53,665 --> 00:21:57,335 Government pools, Medicare advantage, Medicaid managed care. 468 00:21:58,065 --> 00:22:02,255 We're seeing this really rapid growth 469 00:22:02,355 --> 00:22:04,655 of the pay buyer concept. 470 00:22:05,835 --> 00:22:09,935 So I think healthcare five years from now will be more under 471 00:22:09,945 --> 00:22:13,575 capitation, really more focused on delivering care outside 472 00:22:13,575 --> 00:22:16,455 of the hospital walls out into the community. 473 00:22:16,915 --> 00:22:18,415 And I think technology 474 00:22:19,535 --> 00:22:21,755 and these disruptors are gonna help us get there. 475 00:22:21,815 --> 00:22:25,275 So I am so excited to be in healthcare right now 476 00:22:25,555 --> 00:22:27,555 'cause the future looks really, really good. 477 00:22:28,135 --> 00:22:31,115 - And I can tell, I am sure our listeners can hear the 478 00:22:31,115 --> 00:22:32,115 excitement in your voice. 479 00:22:32,655 --> 00:22:35,355 Um, is there anything else you want our listeners to know 480 00:22:35,355 --> 00:22:36,755 before we sign off today? 481 00:22:37,465 --> 00:22:41,515 - Yeah, you know, I'm very proud of the University 482 00:22:41,515 --> 00:22:43,995 of Rochester and the University of Rochester Medical Center. 483 00:22:44,055 --> 00:22:47,155 You know, I was born and raised in, in Rochester, New York. 484 00:22:47,415 --> 00:22:51,075 Um, you know, we're an innovative community home of some 485 00:22:51,075 --> 00:22:54,885 of the, you know, large innovative companies 486 00:22:54,915 --> 00:22:57,365 that our country has seen, like Eastman Kodak 487 00:22:57,785 --> 00:23:00,245 and the birth of the digital camera 488 00:23:00,345 --> 00:23:01,485 and, and digital process. 489 00:23:02,495 --> 00:23:04,405 Xerox, you know, and their influence. 490 00:23:04,575 --> 00:23:08,405 Xerox has had on Apple with Macintosh computers 491 00:23:08,715 --> 00:23:10,005 that came outta Rochester. 492 00:23:10,025 --> 00:23:12,525 And we still embrace innovation 493 00:23:12,705 --> 00:23:15,085 and that ethos in our community that 494 00:23:15,565 --> 00:23:17,285 although today the largest 495 00:23:17,885 --> 00:23:20,165 employer in our community is not no longer a big tech 496 00:23:20,165 --> 00:23:21,285 company like Kodak 497 00:23:21,285 --> 00:23:23,885 or Xerox, it is the University of Rochester. 498 00:23:23,945 --> 00:23:25,605 It is an academic health system. 499 00:23:26,665 --> 00:23:29,565 We wanna be on the cutting edge, we wanna be innovative. 500 00:23:30,185 --> 00:23:32,845 And, you know, to do that, it's gonna be a team sport 501 00:23:33,625 --> 00:23:37,325 and we wanna work with others that have that same why 502 00:23:37,945 --> 00:23:40,605 and essentially create this coalition of the willing 503 00:23:40,745 --> 00:23:43,445 and bring people to work with us in Rochester. 504 00:23:43,465 --> 00:23:46,045 And we may not, you know, do as well 505 00:23:46,345 --> 00:23:49,845 as the health systems in Silicon Valley 506 00:23:50,225 --> 00:23:51,445 or some of the Boston 507 00:23:51,745 --> 00:23:54,205 or New York City who have better branding, 508 00:23:54,205 --> 00:23:55,405 better presence than us. 509 00:23:55,865 --> 00:23:58,885 But I want the world to know we are leaders in Rochester. 510 00:23:59,225 --> 00:24:00,565 We wanna make healthcare better, 511 00:24:00,785 --> 00:24:02,005 and we wanna do it with others. 512 00:24:02,625 --> 00:24:06,205 So if there are other health systems, industry partners, 513 00:24:07,045 --> 00:24:09,165 startups reach out to us. 514 00:24:09,415 --> 00:24:12,165 We're always looking for new partners to, to, 515 00:24:12,165 --> 00:24:13,845 to make healthcare better for this country. 516 00:24:14,035 --> 00:24:16,125 - Awesome. Well, thank you so much for your time today. 517 00:24:16,125 --> 00:24:17,125 It's been an absolute pleasure 518 00:24:17,285 --> 00:24:18,165 speaking with you, Michael. Love 519 00:24:18,165 --> 00:24:19,165 - Dictate. 520 00:24:19,165 --> 00:24:19,605 Thank you. All right. 521 00:24:22,195 --> 00:24:24,925 - It's so important for leaders at the top of organizations 522 00:24:24,925 --> 00:24:27,445 to keep learning, stay sharp, grow their networks, 523 00:24:27,835 --> 00:24:30,285 help our audience better do this in a more simplified, 524 00:24:30,285 --> 00:24:31,965 personalized, and meaningful way. 525 00:24:32,525 --> 00:24:35,005 Becker's Healthcare has launched my BHC, 526 00:24:35,435 --> 00:24:37,325 it's your trusted Becker's healthcare experience 527 00:24:37,325 --> 00:24:39,565 and more with content, connections, events, 528 00:24:39,625 --> 00:24:40,765 and learning opportunities. 529 00:24:41,475 --> 00:24:43,325 Join the community free of charge at 530 00:24:44,065 --> 00:24:48,325 www.my.beggarshospitalreview.com and we'll see you there.